Provider Demographics
NPI:1003506403
Name:TZOBANAKIS, ANASTASIA SOPHIA (ARNP)
Entity Type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:SOPHIA
Last Name:TZOBANAKIS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:ANASTASIA
Other - Middle Name:SOPHIA
Other - Last Name:JENNINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10475 FLYCATCHER RD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613
Mailing Address - Country:US
Mailing Address - Phone:352-263-1068
Mailing Address - Fax:
Practice Address - Street 1:10475 FLYCATCHER RD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613
Practice Address - Country:US
Practice Address - Phone:352-263-1068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9351457363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily